We are seeking a detail-oriented and experienced RCM Eligibility Specialist to join our team on a contract-to-hire basis. This fully remote position plays a critical role in ensuring the timely and accurate financial clearance of patient accounts.
The ideal candidate thrives in a fast‑paced environment, is meticulous in their work, and has a strong background in eligibility verification, claim error resolution, and clean claim submission.
Responsibilities
1. Eligibility Verification
- Conduct thorough reviews of patient insurance coverage and benefit eligibility for laboratory services.
- Communicate with teammates, clinics, patients, and insurance companies to verify coverage and resolve discrepancies.
- Accurately document eligibility information within the revenue cycle management system.
2. Claim Error Processing
- Analyze and resolve claim errors identified by the RCM system, including coding and billing discrepancies.
- Collaborate with teammates to resolve errors and ensure compliance with internal policies and procedures.
- Identify and resolve issues related to medical necessity.
- Perform other duties as assigned.
Qualifications
- College degree preferred, or equivalent experience (5+ years).
- Minimum of 5 years of experience in medical billing, eligibility verification, or financial clearance.
- Strong understanding of HIPAA regulations and proper handling of protected health information (PHI).
- Working knowledge of insurance policies, billing procedures, and claim terminology.
- Excellent communication and interpersonal skills.
- Highly detail‑oriented with strong analytical and problem‑solving abilities.
- Preferred experience with laboratory billing platforms such as Telcor, Xifin, or Quadax.
Skills
- Strong knowledge of insurance guidelines, CPT/ICD‑10 coding, and medical terminology.
- Exceptional attention to detail and time management.
- Strong communication and problem‑solving skills.
- Proficiency with Microsoft Office and healthcare software tools.